Efficacy of the first and subsequent treatment lines with adalimumab in patients with rheumatoid arthritis: data analysis from the Czech National Registry ATTRA

Authors: R. Horváth 1;  J. Hurňáková 2;  R. Janková 1;  T. Philipp 3;  L. Szczuková 4;  K. Hejduk 4;  K. Pavelka 2
Authors‘ workplace: Oddělení revmatologie dětí a dospělých, FN Motol, Praha 1;  Revmatologický ústav, Praha 2;  Revmatologické a rehabilitační oddělení, Thomayerova nemocnice, Praha 3;  Institut biostatistiky a analýz, Lékařská fakulta, Masarykova univerzita, Brno 4
Published in: Čes. Revmatol., 24, 2016, No. 3, p. 78-91.
Category: Original Papers


Therapy with TNFα inhibitors is highly effective, particularly when used in the first line treatment of the patients with rheumatoid arthritis (RA). Satisfactory clinical responses can be achieved in up to 70 % of the subjects during the first year of the administration. Still, a significant percentage of the patients do not respond well, thus alternative treatments need to be searched for. Switching to another TNFα blocker is the most common strategy, supported by the results from different randomized clinical trials which have known limitations. Valuable data regarding the efficacy and safety of individual medications are brought to us from large clinical registries which best reflect a real clinical practice.

The aim of our study was to analyse the efficacy of the first and subsequent treatment lines with TNFα blocker adalimumab within the rheumatoid arthritis patient registry ATTRA.

In the evaluated period, there were total of 1245 RA patients analysed in the complete data file within the ATTRA-RA registry based on the evaluation criteria. 986 patients were treated in the first line and 259 subjects in the subsequent line.

After 24 months, the DAS 28 score in the group treated in the first line with adalimumab reached a mean of 2,8 ± 1,1 (n = 387) vs. 3,0 ± 1,0 (n = 85) for subsequent line (p = 0,020). After two years of treatment, a good response according to the EULAR criteria was achieved in 68,7 % (n = 266) of patients treated in the first line vs. 56,5 % (n = 48) of patients treated in the subsequent line (p = 0,042). After two years of treatment, the remission criteria were achieved in 45,2 % (n = 175) of patients in the first line and in 32,9 % (n = 28) of patients in subsequent line (p = 0,040). After one year of treatment with adalimumab, remission or low disease activity was attained by 41,7 % (n = 20) of patients switching for the reason of ineffectiveness, by 66,7 % (n = 12) of patients switching due to loss of efficacy and by 53,7 % (n = 22) of patients switching due to an adverse events.

Based on the results from the Czech National Registry ATTRA we can conclude that the efficacy of the first and subsequent treatment line with adalimumab is satisfactory and highly effective treatment strategy in clinical practice. The first line treatment was significantly better than the subsequent treatment line in the majority of the evaluated parameters. The subsequent line was highly effective, particularly when the rationale for switching to adalimumab was a secondary failure or a presence of adverse event to the previous TNFα blocker.

Key words:
Rheumatoid arthritis, biological therapy, TNFα inhibitors, adalimumab, subsequent treatment line


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Dermatology & STDs Paediatric rheumatology Rheumatology
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